You know how it goes. You step away from your computer screen for a week in mid-August and stuff happens. The world absolutely refuses to stand still.

You hop on a plane from Newark to San Francisco to see your daughter and her boyfriend, a COVID-delayed trip that was supposed to have taken place in March of 2020.

You stay semi-connected, partially tethered to the world of endless information, skimming over the tops of emails on your iPhone, panning for a few pieces of gold among the 2,000 messages that will accumulate in a week’s time.

The headlines crawl across the screen of your mind like a TV news chyron:

•  The Food and Drug Administration grants formal approval to the Pfizer/BioNTech COVID-19 vaccine for people 16 and older, elevating its status from emergency use authorization.

•  The decision dislodges one brick from the wall of vaccine resistance, Marc Iskowitz reports in MM+M. In a poll by the de Beaumont Foundation, 34% of unvaccinated Americans said the FDA’s full approval will address some or all of their concerns about the safety and effectiveness of the vaccine.

•  The FDA’s action also strengthens the legal foundation for vaccine mandates, Iskowitz notes, which had already been gathering steam and affecting municipal employees, teachers, healthcare workers and college students—not without pushback.

•  A new and broader wave of mandates is expected in the public and private sectors, encouraged by the President of the United States, saluted and adopted by the US military and embraced by a growing number of professional associations and private employers.

•  At the same time, the American Academy of Pediatrics is cautioning doctors against giving the vaccine off-label to kids under 12. Clinical trials in that age group are still in progress with some doses that differ from those given to adolescents and adults.

•  The Pfizer/BioNTech vaccine has a brand name—Comirnaty—that is meant to combine elements of COVID-19, mRNA, community and immunity.

•  Emergency authorization still applies to the Moderna and J&J vaccines and to the use of Pfizer’s vaccine in 12- to 15-year-olds.

That’s all big news but not the only news spinning through the windmills of our minds.

•  Booster doses are in store for most of the vaccinated, starting in September, Diana Ernst reports in MPR.

•  The booster decision is second-guessed by some in the scientific community and decried by others in the global community.

•  COVID-19 hospitalizations for people under 50 hit pandemic highs, most notably for young adults in their 30s and kids under 18.

•  ICU beds fill up, mostly with the unvaccinated; units at 770 hospitals are at 95% capacity.

•  Texas asks FEMA for five mortuary trailers

•  95% of counties in the US are experiencing high (90%) or moderate (5%) transmission of SARS-CoV-2.

•  Thousands of schoolchildren are in quarantine as per COVID protocols, primarily in the South, Midwest and Southwest.

•  The Texas Supreme Court clears the way for mask mandates in schools—for now—in an increasingly edgy chess match between politicians and educators where schoolchildren are the unfortunate pawns.

•  An angry parent in California punches a teacher over elementary school mask policy.

•  Man stabbed, journalist attacked during an anti-vaccination protest at Los Angeles City Hall. 

•  16-year-old in South Carolina dies of COVID-19.

On the brighter side of that sobering coin …

•  The pace of vaccination is picking up once again, to more than a million shots a day over this past weekend.

•  In its first five months, the vaccination campaign in the US prevented nearly 140,000 deaths and 3 million cases of COVID-19, a RAND study reports.

•  Local vaccination efforts soldier on. The Oklahoma City zoo, partnering with the county health department, sets up a COVID-19 vaccination clinic and offers free admission to anyone with proof of vaccination. 

•  Pennsylvania health officials offer weekly COVID-19 testing to K-12 schools statewide. School districts must opt in and student participation is voluntary. The goal is to identify possible outbreaks early enough to interrupt the cycle of transmission. With all the kerfuffle over masks, testing hasn’t gotten as much love and attention as it deserves.

Amid the relentless torrent of news, certain words stay with you.

•  It’s soul-draining.”—Erin Lennon, a physician assistant deployed from Colorado to Delta-ridden Louisiana by the National Disaster Medical System.  Talk about healthcare heroes: Lennon is working cross-country while pregnant with a child due in November. “We all have our ethos and our calling for why we’re doing this,” she told STAT. “This is what we trained for. This is what we do. I can’t walk away from something that’s important just because it’s hard.”

•  “It’s heartbreaking.” –National Institutes of Health Director Francis Collins, describing 90 million unvaccinated Americans who are “sitting ducks” for the virus. Collins also finds it heartbreaking that several states have prohibited mask mandates by schools and local governments.

•  “It’s an act of love.”— Pope Francis, describing the decision to get vaccinated. The Pope and six cardinals and archbishops from North, Central and South America appear in the latest Ad Council/COVID Collaborative PSA, the Ad Council’s first campaign developed for a global audience.

It is a tense and contentious time. Local schools have become the epicenter of simmering tensions over masks and vaccinations, with sign-waving, vocal parents on both sides. We are witnessing extremes, from the Alabama doctor who won’t see unvaccinated patients to the people who won’t accept ”tainted” transfusions from vaccinated blood  donors. We have Arnold Schwarzenegger’sScrew your freedom” message to anti-vaxxers tempered by milder pleas to approach the “wait and see” folks with empathy and encouragement rather than shame and blame.

Behind the scenes and beyond the headlines, the work quietly continues. It is a dual challenge: Getting more people vaccinated and communicating key health messages without causing confusion.

“Public skepticism is high, as messages from the government around the vaccine rollout have continued to change.” That report comes not from the US but Australia, where commercial brands are helping to create a consistent pro-vaccination conversation, Surekha Ragavan reports in Campaign.

To be sure, the Centers for Disease Control and Prevention has issued its share of mixed messages. MM+M’s Lecia Bushak speaks with Trey Watkins, EVP of global health and corporate responsibility at GCI Health, who says it’s not enough to get the science right, as the science keeps changing. The challenge for CDC and other communicators, Watkins says, is to make health information “relatable, approachable and understandable to the layperson.”

One key message worth communicating clearly: In the 10 states with the lowest vaccination rates, COVID-19 hospitalizations are nearly four times greater and deaths 5.5 times greater than in the 10 states with the highest vaccination rates.

Source: Getty Images.

Getting it done

•  A quick look at the CDC vaccination dashboard: the fully vaccinated in the US now include 51.6% of the total population, 60.4% of the vaccine-eligible (age 12 and up), 62.6% of adults and 81.2% of seniors. More than 202 million have received at least one dose.

•  Nano-influencers (those with 1,000 to 10,000 followers) are outperforming celebrities when it comes to getting people vaccinated, Natasha Bach reports in PRWeek. Then there’s Dr. Mike—New Jersey family physician Mike Varshavski—an influencer and by now a celebrity as well, whose vaccination posts on Instagram have reached more than 1 million people.

•  FEMA is multitasking and offering COVID-19 shots at disaster recovery centers in Louisiana and Detroit.

•  The Atlanta Falcons are the first NFL team to report 100% vaccination of their personnel. Vaccination is mandatory for NFL coaches, scouts and front-office personnel but optional for players.

•  As football season arrives, the NCAA and NFL have unveiled their COVID-19 vaccination playbooks. In college, unvaccinated players may be tested up to three times a week and must mask up and practice physical distancing in both athletic and nonathletic activities. Vaccinated players won’t be tested regularly unless they have symptoms or come in close contact with an infected person. In the NFL, if a game can’t be played or rescheduled because of an outbreak among unvaccinated players, the team with the outbreak will forfeit the game—and players for both teams won’t get paid.

•  Texas and Florida are setting up centers for delivering monoclonal antibody infusions to COVID patients in an effort to keep people out of the states’ increasingly COVID-crowded hospitals.

•  The National Association for Home Care & Hospice is partnering with the National Minority Health Association and the federally funded Flex for Checks program, Liza Berger notes in McKnight’s Home Care Daily. Dual goals: use financial incentives to increase vaccination rates among home health workers while boosting vaccination rates and confidence in underserved communities.

Building trust

•  A survey by the Henry Schein Cares Foundation underscores the trust people have in their primary care physician: 34% of adults who had not yet received a COVID-19 vaccination said they would do so if they could get the shot at their doctor’s office. And 88% of those who did see their doctor before getting a COVID-19 shot said the physician’s advice influenced their decision. Trust takes time: Schein says the average patient needs two years and nine months to establish a “meaningful level” of trust with their primary care physician.

•  Face2Face America, a consortium of pharma marketers formed in April, has generated $1.6 million in donated media in support of the vaccination effort, Iskowitz reports in MM+M. The group, now with a dozen partners, is focusing on geographic areas where vaccination rates are lagging and on reaching young adults 18 to 25, employing the trusted voices of healthcare professionals and leveraging the power of storytelling.     

•  The CDC is urging COVID-19 vaccination of pregnant people as well as those who are breastfeeding or contemplating pregnancy. The CDC devoted its most recent COVID Data Tracker Weekly Review to the subject, noting that pregnancy increases the risk of severe, life-threatening COVID-19 and that only 1 in 4 pregnant individuals is now vaccinated.

Source: Getty Images.

Multiplying mandates

•  There is the carrot and the stick, and then there is the cudgel. President Biden has announced that nursing homes must vaccinate 100% of staff or lose Medicare and Medicaid funding. Danielle Brown has details in McKnight’s Long-Term Care News.

•  Leaders in the long-term care industry say that failing to include other healthcare sectors in the defunding policy would be a “tragic misstep” and could have “hundreds of thousands” of nursing home workers heading for the exits. Brown reports on one LTC facility that has figured out how to implement a staff vaccination mandate and achieve 100% uptake without suffering a mass exodus.

•   “Getting upset or angry isn’t going to change the new rules,” says the American Association of Post-Acute Nursing. The group suggests that nursing home leadership remain calm, communicate clearly and designate vaccinated champions within staff who can work diplomatically and empathetically with their colleagues to comply with the order.

•  At least nine states and two cities are imposing COVID-19 vaccination mandates for healthcare workers. In McKnight’s Senior Living, Diane Eastabrook examines the impact of the policy in Maine.

•  Interpublic Group is among those requiring vaccination or testing as a condition of returning to the office, Aleda Stam reports in PRWeek.

•  The Las Vegas Raiders are the first NFL team to require fans to show proof of vaccination, starting with the first home game September 13 against the Baltimore Ravens on Monday Night Football.

•  To comply with a citywide rule, anyone attending a New Orleans Saints’ home game will need proof of vaccination or a recent negative test result to take their seats in the Caesars Superdome.

•  The American Academy of Ophthalmology is requiring proof of vaccination for all persons registering to attend the annual conference in New Orleans in November.

•  Students at Quinnipiac University in Connecticut face weekly fines for failing to provide documentation of COVID-19 vaccination. They will lose access to the campus network and WiFi if not fully vaccinated by mid-September.

•  Most people support mask mandates in school and vaccinations for return to work, according to an Axios-Ipsos poll, with notable skewing along political party lines: 69% support masks in schools (90% of Democrats, 44% of Republicans) and 55% support vaccinations (nearly 80% of Democrats, 30% of Republicans).

Boosters and booster bashing

•  Booster doses received a collective vote of confidence from eight leading US health officials, including the heads of the FDA, CDC and NIH as well as Surgeon General Vivek Murthy and chief White House medical advisor Anthony Fauci.

•  However, the scientific world is not exactly applauding the decision. “I think we’ve scared people. We sent a terrible message,” Dr. Paul Offit, Director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told Kaiser Health News. “We just sent a message out there that people who consider themselves fully vaccinated were not fully vaccinated. And that’s the wrong message, because you are protected against serious illness.”

•  The CDC published several reports explaining the reasoning behind comprehensive boosters. One study found that the Pfizer/BioNTech and Moderna vaccines were 74.7% effective in preventing infection in nursing homes from March to May but just 53.1% effective in the June-July summer of Delta. In another investigation, conducted among more than 4,000 front-line workers from mid-December to mid-August, vaccine efficacy in preventing infections declined from 91% to 66% in the time of Delta predominance.     

•  However, other studies show that vaccines continue to be effective in preventing serious COVID-19 illness and hospitalizations, even during the Delta surge. A report from Los Angeles County finds that as of July 25, the unvaccinated were 4.9 times more likely than the fully vaccinated to develop infection and 29.2 times more likely to be hospitalized with COVID-19.

•  The only officially authorized third dose to date is the emergency use authorization okayed by the FDA on August 12 for the immunocompromised, including recipients of solid organ transplants. The CDC’s Advisory Committee on Immunization Practices will meet next Monday and Tuesday to consider other options.

Source: Getty Images.

Finding equity

•  The move to booster doses in the US and other countries has sparked further outcry from the World Health Organization, questioning the need for third doses when much of the world still awaits a first jab.  Dr. Mike Ryan, director of WHO’s Health Emergencies Program, says it’s like handing out life jackets to those who already have one while leaving others to drown.

•  WHO Director-General Tedros Adhanom Ghebreyesus said that “Vaccine injustice is a shame on all humanity, and if we don’t tackle it together, we will prolong the acute stage of this pandemic for years when it could be over in a matter of months.”

•  In MM+M, Lecia Bushak provides timely insights into the global equity issues raised by the vaccine haves and have-nots.

•  The Pan American Health Organization is buying vaccines for  its member countries in Latin America  and the Caribbean to supplement the amounts received from the struggling global COVAX initiative.

Parting shot

Barry Manilow didn’t quite make it through the rain at the long-awaited We Love NYC Homecoming Concert in Central Park last Saturday night. Manilow was in the middle of Can’t Smile Without You when the duo known as Rain and Lightning, the fringes of Tropical Storm Henri, made an unwelcome guest appearance and forced the event to shut down.

In a way, the half-completed, washed-out concert was an apt metaphor for our summer journey through the pandemic—high hopes of celebration followed by rain on the parade.

Other musical performances are casualties of the Delta storm surge. K-pop megastars BTS canceled their Map of the Soul world tour and Stevie Nicks nixed her US concert dates. Garth Brooks cut short his tour and Neil Young withdrew from Farm Aid while Willie Nelson, Dave Matthews and John Mellencamp still plan to perform at a sold-out show in Hartford, CT on September 25. Attendees will need proof of COVID-19 vaccination or a recent negative test.

On a different stage, the US is asking diplomats from around the world not to attend the United Nations General Assembly in person next month, lest it become a super-spreader event, and to send a video message instead.

… and some songs

The Windmills of Your Mind, Noel Harrison

Crying in the Rain, Everly Brothers

Have You Ever Seen the Rain, Creedence Clearwater Revival

Set Fire to the Rain, Adele

Here Comes the Rain Again, Eurythmics

Move, Santana, Rob Thomas, American Authors

Kar de Kamaal Tu, Indian Theme Song for 2020 Paralympics (now under way in Tokyo)

Thanks so much for joining us. Take care, be well, stay safe and see you in September — that’s next Wednesday.